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Plagiocephalometry: a non-invasive method to quantify asymmetry of the skull; a reliability study

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Abstract

Deformational plagiocephaly (DP) in newborns and very young children is a common problem in daily practice. The intrarater and interrater reliability of plagiocephalometry (PCM), a new, non-invasive, inexpensive instrument to assess and quantify the asymmetry of the skull, is evaluated at the outpatient Department of Physical Therapy of the Bernhoven Hospital at Veghel, The Netherlands. Using a thermoplastic material to mould the outline of the infant’s skull, a reproduction of the skull shape is performed on paper, allowing for accurate cephalometric measurements. Fifty children (aged 0–24 months), with or without positional preference of the head, and with or without DP, were measured three times by two separate, experienced pediatric physical therapists. Intraclass correlation coefficients (ICC) regarding the measurements of the drawn lines were all above 0.92 (intrarater reliability) and 0.90 (interrater reliability). The ICCs of the plagiocephaly indicators ear deviation (ED), antero-sinistra−antero-dextra (ASAD), postero-dextra−postero-sinistra (PDPS) and oblique diameter difference (ODD) were 0.88, 0.57, 0.92 and 0.96, respectively, for the intrarater reliability and 0.90, 0.65, 0.94 and 0.96, respectively, for the interrater reliability. The ICCs of the two indices oblique diameter difference index (ODDI) and cranial proportional index (CPI) were 0.97 and 0.96, respectively, for the intrarater reliability and 0.95 and 0.92, respectively, for the interrater reliability. The limits of agreement according to Bland Altman, comprising 95% of the differences between two measurements (2 sd), were 4.3 mm (ED), 5.9 mm (ASAD), 3.0 mm (PDPS), 3.4 mm (ODD), 2.7% (ODDI) and 4.5% (CPI) for the intrarater reliability, and 3.7 mm (ED), 5.2 mm (ASAD), 2.4 mm (PDPS), 3.3 mm (ODD), 2.9% (ODDI) and 5.8% (CPI) for the interrater reliability. Conclusion: We conclude that PCM is an easy-to-apply, non-invasive and reliable measurement instrument to assess skull asymmetry with good clinical accuracy and low application costs. PCM might serve as an instrument to be used in all levels of care for children with DP, and might provide information concerning the natural course of DP, as well as the assessment of the effects of conservative treatment strategies on DP.

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Abbreviations

ASAD:

Antero-sinistra−antero-dextra

CPI:

Cranial proportional index

DP:

Deformational plagiocephaly

ED:

Ear deviation

ICC:

Intraclass correlation coefficients

ODL:

Oblique diameter left

ODR:

Oblique diameter right

ODD:

Oblique diameter difference

ODDI:

Oblique diameter difference index

PCM:

Plagiocephalometry

PDPS:

Postero-dextra−postero-sinistra

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Acknowledgements

The authors thank Lonneke van Soest, PT, PCS, MA and Judith Timmers, PT, PCS, BSc of the Department of Physical Therapy, Bernhoven Hospital, Veghel, The Netherlands, for their contribution in the acquisition of the data.

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Authors and Affiliations

  1. Department of Physical Therapy, Bernhoven Hospital, Veghel, The Netherlands

    Leo A. van Vlimmeren

  2. Department of Pediatric Physical Therapy and Exercise Physiology, University Medical Center, Wilhelmina Children's Hospital, Room KB 02.056.0, P.O. Box 85090, 3508 AB, Utrecht, The Netherlands

    Tim Takken, Paul J. M. Helders & Raoul H. H. Engelbert

  3. Department of Plastic and Reconstructive Surgery, Erasmus University Medical Center Rotterdam, Sophia Children's Hospital, Rotterdam, The Netherlands

    Léon N. A. van Adrichem

  4. Julius Centre for Health Sciences and Primary Care, Clinical Epidemiology, University Medical Center, Utrecht, The Netherlands

    Yolanda van der Graaf

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  1. Leo A. van Vlimmeren
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Correspondence to Raoul H. H. Engelbert.

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van Vlimmeren, L.A., Takken, T., van Adrichem, L.N.A. et al. Plagiocephalometry: a non-invasive method to quantify asymmetry of the skull; a reliability study. Eur J Pediatr 165, 149–157 (2006). https://doi.org/10.1007/s00431-005-0011-1

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  • DOI: https://doi.org/10.1007/s00431-005-0011-1

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